Sarah Clark was worried about her 3-year-old daughter. Adrienne had multiple temper tantrums an hour, hour after hour, and their house was constantly filled with her screaming. Sarah worried, too, about the affect the unrest might be having on her older son. Sarah and her husband doubled down on their discipline tactics, and on the advice of their pediatrician, they took Adrienne to a child psychologist. After several sessions the psychologist suggested ADHD medication. When none of that worked, the child psychologist recommended Adrienne be put on an anti-psychotic medication called Risperdal.
"Excuse me?" Sarah asked, thinking she'd heard the doctor incorrectly. "Are you suggesting that my 3-year-old is bipolar?" Sarah works as a speech therapist for an elementary school district. As a result, she knows a fair amount about Risperdal, and what it's used for. She's seen kids and their haggard parents come through her office door, and the kids who are on Risperdal are literally sedated.
"That's exactly what I'm thinking," the doctor replied.
Sarah sought a second opinion. This time she attended without Adrienne, and was careful not to let the psychiatrist hear her desperation. She wanted an objective assessment, not one colored by her distress. This time the psychiatrist said, "It sounds like your daughter is on the Asperger's scale," and she, too, suggested Risperdal.
"I'm a speech therapist," Sarah told the doctor, "and I know what Asperger's looks like. My daughter does not have Asperger's. What's more, you haven't even seen her. How can you make that assessment?" The doctor suggested that Sarah was in denial.
When Sarah returned to her car, she started sobbing. She was frustrated she wasn't getting the help her intuition told her she needed for Adrienne, but she was also heartbroken for all those kids who had walked through her office door. If this was the cavalier way doctors handed out prescriptions for Risperdal -- a medication that causes serious side effects -- she knew those kids may not have needed to be on the medication any more than Adrienne did.
Despite Sarah's harrowing story, this is not an anti-medication diatribe, and in fact I become short-tempered with the likes of those who stubbornly refuse to vaccinate their children. Science is wonderful, and medication can be incredibly helpful. But not nearly as many children need medications as are currently on it, and many are far too young to be on anything. Most psychologists don't think children should be given a diagnosis before the age of seven. While Sarah had the benefit of her professional experience to educate her about what various diagnoses mean and look like, most parents do not have such a benefit. Taking care of children can be extremely challenging at times, and we all understand there can be a desire to "just fix it!" But rather than turning quickly to medication, parents should consider all the angles when a child is suffering and a treatment plan seems in order.
One way American society in particular thinks it can fix problems is by handing out labels. For instance, the diagnosis of ADHD in children has risen by 41 percent in the past decade, and many who care for children -- myself included -- think that it's over-diagnosed. Children are labeled for exhibiting normal kid behavior, and medicated inappropriately, which is a travesty. Dr. Jerome Groopman, a professor of medicine at Harvard and the author of How Doctors Think, refers to the phenomenon as "medicated, not educated." He told the New York Times, "There's a tremendous push where if the kid's behavior is thought to be quote-unquote abnormal -- if they're not sitting quietly at their desk -- that's pathological, instead of just childhood." This push to label is dangerous, and has wider implications than parents realize. A friend of mine put her teenager on Aderall, a stimulant, for three weeks. Several years later when he wanted to go to flight school, he couldn't because the medication was on his record. Labels can stick with children for the rest of their lives. They can affect and limit their choices, and they can become self-fulfilling prophecies.
That's not to say all behavioral problems are just kids being kids. Some children, like Adrienne, have trickier problems that need professional help. But what all scenarios on the spectrum have in common is the need to look at a child's life holistically. In my sphere as a nanny and parent educator, this means examining their sleep, diet, schedule, the quality time they get with their parents, their self-esteem, their adherence to boundaries, and more. You simply cannot look at one thing and not all of the others, or you will miss the big picture. Once you've checked off all the boxes, then it's time to get a professional opinion, but one that will likewise take all facets of a child's life seriously.
Two years and a lot of research and tantrums later, Sarah and her husband found the root of Adrienne's behavioral issues. She has a sensory processing disorder, which means that she is deeply affected by stimuli such as bright lights and too much sound. She also has a dairy allergy that was probably making her very uncomfortable and irritable. Adrienne went to occupational therapy to learn techniques -- such as swinging, jumping, and brushing -- to deal with her triggers, and Sarah eliminated dairy from the family diet. "Our home life has improved dramatically," Sarah said. Nearly a year after going to occupational therapy for the first time, Sarah says things have remained 80 percent better than before. And Adrienne isn't on a single medication.
The road Sarah went down with Adrienne is not one I'd wish on anyone. But I admire her. She trusted her gut, and she was willing to pull up her socks and do the hard work of figuring out the problem's roots instead of looking to the quick fix. If you cover up a problem with medication, how can you tell what's causing it? What's more, medication isn't even the quick fix we think it is. In many cases, it doesn't help, it can make things worse, or it can completely mask a serious problem. Behavioral problems are not like skinned knees that just need some ointment and a bandage. They are complex. They need time to resolve, and they need a holistic approach. This isn't a diatribe on Riserdal or Ritalin, but it is an attack on those who would jump to conclusions. Pediatricians, therapists, teachers, parents -- stop labeling and medicating children. Pull up your socks and make sure you've done everything you can to figure out what the problem is first.